ThermaCool

ThermaFrax--- Combination Treatment ofThermaCool and Fraxel ---台大醫院皮膚部主治醫師美麗境界診所院長曾忠仁

Methods of Skin ResurfacingHighABLATIVEEFFECTIVENESSCO 2ERBIUMFRAXELTHERMACOOLCHEMICAL PEELSMICRODERMABRASIONNON-ABLATIVELowSAFETYHighBoth Fraxel and ThermaCool are high safetytreatment modalities.

R134a CoolingControl Module330 Watt6 MegahertzHigh FrequencyRF GeneratorThermaCool TC System• Canadian HPB Clearance for Aesthetic Use• FDA 510K Clearance for Aesthetic Use

Thermage ThermaCool TC• CRF (Capacitive Radio Frequency) for tissuetightening• FDA indications– Non-invasive treatment of wrinkles and rhytids on• Periorbital region (forehead and area around the eyes)• Mid/lower face (cheeks, area around the mouth, chin,jowls, and jaw line).• Off-faceface– Acne vulgaris and acne scar (Canadian HPB)

ThermaCool TC SystemComputer Simulation of TemperatureProfileTemp(°C)Depth (mm)

ThermaCool TC SystemSub-Dermal Heating*EpidermisDermisSub-cutaneous FatMuscle*Hypothetical heating profile1.5 cm 2 Deep Tip

Depth of Heating63% of energy deposited within these depths0ThermaTipDeepThermaTipMediumThermaTip ThermaTipShallow SuperficialPulse Dye465 nmDiode830 nmNd:Yag1064 nmCO210600 nmSmoothBeam CoolTouch1450 nm 1320 nmN-Lite585-500Treatment Depth (microns)-1000-1500-2000-2500Current-3000-3500Laser data from Optical-Thermal Response of Laser-Irradiated Tissue by Welch and van Gemert.Thermage data by Thermage Research based on a single-layer homogenous tissue model.Thermage Deep, Shallow, Superficial and ¼ cm 2 tips are under development.

FRAXEL SR LASER• 1.55 nm fiber laser• Weight: 23 kilos (without base)• Adjustments for energy and spotdensity• Intelligent Optical TargetingSystem: Robotic handpiece laysdown consistent MTZ patternindependent of velocity.• Disposable tips (2 sizes)

Fraxel• FDA approved for– 2003• Soft tissue coagulation– 2004• Skin resurfacing• Periorbital wrinkles• Pigmented lesions, including age spots, sun spots and skindiscoloration– 2005• Melasma– 2006• Acne and surgical scars

NON-ABLATIVE FRACTIONALRESURFACING• Non-Ablative• Tissue is coagulated, not vaporized• The stratum corneum remains intact• Fractional• Multiple 70-150 micron MicroThermal Zones(MTZs)) surrounded by islands of viable tissue• Resurfacing• Extrusion & replacement of damaged tissue• Rapid re-epitheliazationepitheliazation (within 24hrs)• Collagen denatured between300-900 microns indepth

ThermaCool and Fraxel• ThermaCool– Deep tissue tightening– Depth• Fraxel• Upto 2000 - 3000 um deep• Dermis and subQsubQ, , epidermis spared– Fractional resurfacing– Depth• 300 – 900 um• From epidermis to superficial dermis

ThermaFraxNon invasive tissue tighteningplus Fractional Resurfacing300 - 900 umFraxel2000 - 3000 umThermaCoolDeep tissue tightening

ThermaFrax• Combination treatment of ThermaCool andFraxel– Initial ThermaCool treatment– A series of Fraxel treatment• Indications– Skin rejuvenation– Acne scar

Acne scar• 29 y/o male– Received Cooltouch laser and Er-YAG laserdermabrasion before– IPL and Dye laserfacial between ThermaFrax• ThermaCool RF twice– 1.0 cm 2 tip x 150 shots, level 14-1616• Fraxel once– 12mJ x 1000 mtz/cm2– Total 5.09 KJ/tx

20040307 before tx 20060705, 4 wk after 1 tx



Acne scar• 37 y/o male– Jessner’s peeling• ThermaCool once– 1.0 cm 2 tip x 150 shots, level 12-1414• Fraxel 3 tx until 20060716– 15-20mJ x 1000-1500 1500 mtz/cm2– Total 5.00-6.02 KJ/tx

20040620 before tx 20060716, 6 wk after 2 fraxel tx

20040620 before tx 20060716 , 6 wk after 2 fraxel tx

20040620 before tx 20060716 , 6 wk after 2 fraxel tx

20040620 before tx 20060917, 2 mo after 3 fraxel tx



Acne scar• 22 y/o female• Acne scar• ThermaCool RF once– 1.5 cm 2 tip x 150 shots, level 61-6565• Fraxel once• 12-1515 mJ x 1000-1250 1250 mtz/cm2– Total 3.53 KJ

20060408 before tx 20060426, 3 weeks after 1tx






Acne scar• 35 y/o male• Acne scar• ThermaCool RF once– 1.5 cm 2 tip x 450 shots, level 62-65.565.5• Fraxel 6 tx– 12-2020 mJ x 1000-1500 1500 mtz/cm2– Total 5-656 KJ/tx

20060107 before tx2006063 1 wk after 3 tx











Facial Rejuvenation• 49 y/o female• ThermaCool RF once– 3.0 cm 2 tip x 300 shots, level 353.5-356.5356.5• Fraxel once• 12mJ x 1000-1250 1250 mtz/cm2– Total 4.04 KJ

20060530 before tx 20060628, 1 wk after tx



Faial RejuvenationChloasma and Acne Scar• 45 y/o female• Fraxel laser for both cheeks– 6 mJ x 250 MTZ x 8 passes or– 12mJ x 125 MTZ x 8 passes– Total 2.5 KJ– 3 treatments• Combination treatment– Transamine– Vitamin C

20060415 before tx 20060613 2 weeks after 3 treatment

Chloasma20060415before tx200606132 weeksafter 3treatment






Faial RejuvenationChloasma and Acne Scar• 45 y/o female• Very satisfied with the result after 3 Fraxellaser treatments• ThermaCool RF for facial skin tightening– 3.0 cm 2 tip x 300 shots, level 352.5-356356

20060415 before tx 20060915 1 mo after Thermacool tx



Advantage of ThermaFrax• Short or even no downtime• Relatively minimal invasive• Easy post operative care• Progressive improvement• Long term effect• Safe and effective procedure

Disadvantage and Complication ofThermaFrax• High expense• Long term and painful treatment courses• From ThermaCool– Burn or even bullae formation– Tissue wasting and/or surface irregularity• From Fraxel– Pigmentation change• Hyperpigmentation• Hypopigmentation– Herpes simplex

Key to Success• Communication with the patient– Be honest– Proper expectation• Standard operation procedure• Never over treat

FRAXEL SR TREATMENT DENSITY ZONE

BIOLOGICAL RESPONSEMinimalFlakingBlisteringOptimumTherapeuticWindowAblative like ResponseClinical Effects

Conclusion• ThermaFrax– Very effective in the treatment of acne scarand facial rejuvenation– Possible PIH, especially in darker skin patients– Further indication• Striae distensae

The end.Thank you for your attention.

ThermaCool

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